Provider Demographics
NPI:1740081272
Name:GOLEMON, KATELYN MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:MARIE
Last Name:GOLEMON
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 PALESTRA DR APT 21
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2643
Mailing Address - Country:US
Mailing Address - Phone:309-397-1772
Mailing Address - Fax:
Practice Address - Street 1:400 1ST CAPITOL DR STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2881
Practice Address - Country:US
Practice Address - Phone:636-947-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025008968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist